CCBD: Stem Cell Transplantation

Why Children's?

Children's Medical Center is the only academic medical center in North Texas that offers stem cell transplantation to children with a variety of malignant and non-malignant disorders. Because of its affiliation with The University of Texas Southwestern Medical Center, children treated at Children's have access to therapies years before these treatments are widely available. In conjunction with UT Southwestern, the program is also FACT (Foundation for the Accreditation of Cellular Therapy) accredited. The Children's stem cell transplant team approaches care from every angle, including physical, social, psychological and financial. We attempt to not only care for your child but for your whole family.

Transplant Highlights

• Children's has performed more than 250 transplants since the program start in 1992.
• Children's is the only Hematopoietic Stem Cell Transplant Center with a dedicated immunologist in North Texas.
• The recent expansion of Children's Medical Center provided a new Hematopoietic Transplant Unit with 12 beds, equipped with state-of-the-art equipment.

What We Treat

Children's is experienced in treating both malignant and non-malignant disorders using stem cell transplantation. The following is a list of our most common reasons for stem cell transplantation.

• Acute myelogenous leukemia
• Hodgkin's lymphoma
• Neuroblastoma
• Aplastic anemia
• Fanconi's anemia
• Wiskott - Aldrich syndrome
• Primary immunodeficiencies
• Hyper- IGM
• Relapsed or high-risk acute lymphoblastic leukemia

Our Services

Children's offers autologous, related and unrelated allogeneic and umbilical cord transplants. The program also works closely with a pediatric immunologist to optimize care of children with primary immunodeficiencies.

What to Expect

If your visit is for the day (outpatient)

Please plan to arrive to your appointment 15 minutes early. A typical visit in our clinic consists of lab work, and physical by a midlevel provider and physician, and any additional test or infusions that may be warranted. The length of visit varies but usually the average length is three hours from check-in to check out. We ask that you bring the following things to clinic with you:

• Your current insurance card
• Your child's medications
• Snacks/drinks for your child

The clinic tends to be cold. You may want to bring a light jacket or sweater.

If your visit is overnight (inpatient)

We encourage parents to stay with their children while they are hospitalized. Each patient room has accommodations for one parent to stay, including a chair or sofa that converts into a single bed. A private bath is also in each room. Food is available in our cafeteria, and you also may purchase a tray for yourself to be delivered with your child's meal.

For other family members, we recommend nearby hotels. Our social services department offers a reservation service known as "Suite Dreams" to help families with medical needs receive discounted rates at local hotels. For Suite Dreams assistance, call 1-800-955-ROOM. The social services department also can make referrals to the Ronald McDonald House for families of patients.

What to bring

• Your child's robe and slippers and favorite stuffed animal or toy (A favorite stuffed toy can serve as a "security blanket" and accompany your child into surgery, the recovery room or the intensive care unit).
• Extra clothing for you and your child.
• All medicines taken by your child (give to your nurse when checking in).
• Insurance information and other important documents, including your child's immunization record.
• Any medications or other items parents will need while away from home.

Suggestions for parents

Child life specialists at Children's suggest you prepare your child for his stay by considering these ideas:

• If children are old enough to understand, tell them in advance about the upcoming hospital stay. Older children can be told about their medical condition, the procedures required and other details about hospitalization earlier than younger children. A younger child generally should not be told until a few days before the hospitalization.
• Try to answer your child's questions about the hospital honestly. You may want to try to explain what the child can expect while at the hospital.
• Reassure your child that you or another family member will be nearby while your child is in the hospital to make sure he or she is all right.
• Pack some special items from home. Familiar objects will help your child feel more comfortable in a strange place. A favorite toy can serve as a security blanket and can accompany your child into surgery, the recovery room or to the intensive care unit.
• Siblings may find a child's hospitalization almost as stressful as the patient does. The best way to alleviate their fears is to bring them with you on a visit to the hospital. Probe for and correct any misconceptions your children may have about a brother's or sister's illness or about hospital procedures. After the hospitalization is over, set aside time for communication and activities with each child individually.
• Remember, our child life staff is here to help. If you need more information or would like to speak with a child life specialist directly, please feel free to contact the child life department at 214-456-6280.

Research

The Hematopoietic Stem Cell Transplant team is an active participant in institutional based research projects and cooperative group research. The team has open protocols with Children's Oncology Group (COG), National Marrow Donor Program/Center for International Blood and Marrow Transplant Research (NMDP/CIBMTR), Pediatric Blood and Marrow Transplant Consortium (PBMTC) and Blood and Marrow Transplant Clinical Trials Network (BMT CTN). The following is a list of the current open protocols at Children's:

• NMDP
• ONC-032P
• ASCT 0521- Enbrel (Etanercept)for the treatment of Acute, Non-infectious Pulmonary Dysfunction following Allogeneic SCT
• ASCT 0631 (currently not opened to accrual)- A Phase II Randomized Trial of G-CSF Stimulated Bone Marrow vs. Conventional Bone Marrow as a Stem Cell Source in Matched Sibling Donor Transplantation
• Gentium: Defibrotide for Hematopoietic SCT Patient with Severe Hepatic VOD: A treatment IND study
• 0603- A Multi-center, Phase II Trial of Nonmyeloablative Conditioning (NST) and Transplantation of Partially HLA-Mismatched Bone Marrow for Patients with Hematologic Malignancies
• ASCT 0431- A Randomized Trial of Sirolimus-Based Graft Versus Host Disease Prophylaxis After HSCT in Relapsed ALL
• 0301- Fludarabine-based Conditioning for Allogeneic Marrow Transplantation from HLA-compatible Unrelated Donors in Severe Aplastic Anemia
• Amgen: A Phase 1 Dose-Escalation Study to Evaluate the Safety and PKs of Palifermin in Pediatric Subjects with Acute Leukemias Undergoing Myeloablative Therapy and HSCT
• 0501: Single vs. Double UCB Transplantation in Patients with High Risk Leukemia and Myelodysplasia
• 0601: Unrelated Donor Hematopoietic Cell Transplantation for Children with Severe Sickle Cell Disease Using a Reduced Intensity Conditioning Regimen
• 0802: A Multi-center, Randomized, Double-blind, Phase III Trial Evaluating Corticosteroids with Mycophenolate vs. Corticosteroids with Placebo as Initial Systemic Treatment of Acute GVHD
• Fatigue and Hope post transplant
• TCRN
• PIDTC- IRB approved (NR-3 pending)

Meet the Team

Children's has a dedicated team for Hematopoietic Stem cell Transplant that is highly trained and eager to make life better for your child. The team works as a cohesive group to formulate a plan of care that is individualized for your child, for the best possible outcomes. Comprised of doctors, mid-level providers, nurses, social workers, child life specialists, dietitians, psychologists, financial services representatives, we are here to make sure both the needs of you and your child are met during and after the process of transplant.

Andrew Y. Koh, M.D. - Director
Victor M. Aquino, M.D. - Pediatric Transplant Specialist
Tiffany Simms-Waldrip, M.D. - Pediatric Transplant Specialist
Tanya C. Watt, M.D. - Pediatric Transplant Sepcialist 
Maite de la Morena, M.D. - Pediatric Immunologist 
Jane D. Siegel, M.D. - Pediatric Infectious Disease
Cecilia Gladbach, RN, BSN, CPON - Transplant Coordinator
Ignacio Vasquez, RN, BSN - Transplant Coordinator 
James DeMasi, RN, CPNP - Nurse Practitioner
Tara Pavlock, RN, CPNP - Nurse Practitioner
Stacy Ettinger, RN, CPNP - Nurse Practitioner
Kara Waters, RN, CPNP - Nurse Practitioner
Cara Zbylut, RN, CPNP - Nurse Practitioner
Jessica Anderson, RN, CPNP - Nurse Practitioner
Jessica Bailey, RN, CPNP - Nurse Practitioner
Jennifer Sheiner, RN, CPON - Transplant Nurse
Diane McGinnis, LCSW - Social Worker
Ruthie Davis, CCLS - Child Life Specialist
Julie Germann, Ph.D. - Pediatric Psychologist 
Gevel Jackson, BA, CCRP - Clinical Research Coordinator
Niechelle Loyd, BS, MA - Clinical Research Coordinator
Paula Kelley, MT (ASCP) SBB - Accreditation Specialist